A coach is a person who guides, interprets, and explains an unfamiliar social situation to a potential patient. The overall strategy of the coach is to help prepare the patient to present him/herself to the institution so that he or she will be given entree. A person may be sought as coach because he or she has illness-specific or institution-specific knowledge, or is a usual confidant. There are four types of coaches: the sidelines coach, the player-coach, the behindthe-scene coach, and the direct-line coach. Coaches may be formal or informal. The customary medical patient must establish a number of credentials in order to be considered a bona fide recipient of services: somatic, financial, social, and politicallideological. Not all institutions require all credentials, nor are they all given equal weight. The coach's functions are: to teach the patient how to present hislher credentials; to help decide which credentials are important for a particular institution; to assess the strength of the patient's credentials; to help decide whether the credentials may be successfully established. The institution responds by accepting or rejecting the credentials. Once rejected, the patient may call upon an arbitrator, who attempts to establish a credential consensus by forcing a reassessment of the credentials or a waiver of the credentialing process. Arbitrators may be formal or informal, but must have some basis of authority in order to be effective. Tactics used by arbitrators are: bargaining, plea of dire consequences, and appeal to higher authority. Coaches and arbitrators may be used sequentially or simultaneously, or they may serve in a combined capacity.
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